Red child syndrome.

An acute overdose of rifampicin in an 18 month old white infant is described. The characteristic signs of the syndrome: orange-red discolouration of the skin, urine, and tears, facial pruritus, and periorbital oedema were present and the outcome was uneventful. Paediatricians should be aware of this peculiar yet easily identifiable syndrome.

Intractable diarrhoea of infancy and latent otomastoiditis.

In 16 infants with intractable diarrhoea, latent otomastoiditis was found in 9 (3 at necropsy and 6 at myringotomy-antrotomy). In 5 of the 6 operated group, surgery was followed by a striking cessation of the diarrhoea and with weight gain. It is concluded that (1) latent otomastoiditis may be a perpetuating factor in intractable diarrhoea; (2) myringotomy-antrotomy should be considered if other forms of treatment have failed, and especially if there is leucocytosis; (3) mastoiditis with diffuse osteitis seems to be associated with a poor prognosis.

Reaction of rectal mucosa of celiac patients to direct contact with gluten.

It is assumed that the colonic mucosa of celiac patients is not sensitive to gluten. This assumption has been supported by the absence of clinical manifestations of colonic involvement in patients with active celiac disease which, by itself, does not confirm insensitivity to gluten. Eight children, aged from 11 to 25 months, with an initial diagnosis of celiac disease were studied: in five children a definite diagnosis has already been confirmed. Rectal gluten challenge was done by means of retention enemas. A volume of 100 ml of a 10% gluten suspension in water was introduced into the rectum three times per day for 8 days; each enema was retained at least 1 h. Rectosigmoidoscopies and rectal biopsies were done before and at the end of the challenge period. The endoscopic appearance of rectal mucosa was normal in all the children either before or after gluten challenge. The means of total mucosal thickness, intraepithelial lymphocyte counts, mitotic crypt cell activity, and cellular infiltration of lamina propria increased after challenge; the mean of goblet cell/epithelial cell ratio in the surface epithelium decreased. The differences between each pair of means (before and after challenge), however, were not significant except for total mucosal thickness (p less than 0.05), the meaning of which is unclear. This study did not definitely demonstrate that the rectal mucosa of celiacs is insensitive to gluten. For practical clinical purposes, however, it behaves as such. This makes the rectal mucosa a useless tool for the final diagnosis of celiac disease.

Late onset coeliac disease in the monozygotic twin of a coeliac child.

A case of late onset coeliac disease (confirmed by serial intestinal biopsies) is described in the monozygotic twin of a coeliac patient. This is the second case reported in literature. The permanent discordance for coeliac disease in monozygotic twins is questioned.

Cow's milk protein-sensitive enteropathy: number and timing of biopsies for diagnosis.

Intestinal biopsy is an essential procedure in the diagnosis of cow's milk protein-sensitive enteropathy. The number and timing of biopsies, however, is still controversial. Twenty-two infants who were clinically suspected of having cow's milk protein intolerance were put on a milk-free diet, during which they all improved. In the first 14 infants (Group I), milk withdrawal lasted 6-8 weeks; in the following 8 infants (Group II), milk withdrawal lasted 3.5-4 months. At the end of the withdrawal period, each patient was submitted to an oral lactose tolerance test and then to a first jejunal biopsy, followed by a cow's milk challenge, and a second biopsy (1-2 days later). None of the infants showed evidence of lactose intolerance, but they all reacted adversely to milk reintroduction. In Group I, the distribution of mucosae from grade 0 (normal) to III was almost the same before and after challenge (p greater than 0.5); this is considered to be due to the severe mucosal damage still present in prechallenge biopsies. In Group II, however, a significant difference was found in the distribution of mucosae before and after challenge (p less than 0.05), and a deterioration could be observed in each case after challenge. Intraepithelial lymphocyte counts and mitotic index determinations before and after milk reintroduction were of no diagnostic value in either group. It is suggested that the diagnosis of cow's milk protein-sensitive enteropathy may rely on two biopsies, the first after a period of 3.5-4 months on milk-free diet and the second following milk challenge.

[Intestinal mucosa in rats with iron deficiency anemia]. / Muqueuse intestinale dans l'anémie ferriprive du rat

Eighteen albino rats at the age of 15 days were separated in 2 groups of 9 and fed cow's milk exclusively. The milk supplied to the control rats (group I) was supplemented with iron and copper. The months later, the rats were scarificed. The animals of group II were severely anaemic. In each rat, a histological examination of gastric (in group II, only in 2 rats) and jejunal mucosa as well as measurements of total thickness, villous height, epithelial cell height and mitotic index were made. Histology was normal in all the rats. Measurements gave similar results in both groups except for the epithelial cell height which was significantly higher in anaemic rats than in controls. The authors take issue with the methodology followed in previous studies concerning iron-deficient children and suggest that the causal relation between iron deficiency and structural changes of intestinal mucosa in children has not yet been proven.

Alimentos genéticamente modificados / Genetically modified food

La elaboración de alimentos genéticamente modificados ha sido uno de los avances más importantes en la producción de alimentos de la última década. En esta revisión se resumen las técnicas para la introducción de nuevos genes o modificaciones del genoma de las plantas, sus consecuencias y el debate sobre las ventajas y los posibles riesgos del cultivo y el consumo de este tipo de alimentos (AU)

Elaboration of genetically modified foods has been one of the most important advances in the production of foods in the lat decade. In this review, the techniques for the introduction of new genes or modifications of the plant genome, their consequences and the debate on the advantages and possible risks of the growing and eating of this type of foods are summarized (AU)